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Freedom Blue PPO Valor (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Valor (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Freedom Blue PPO Valor (PPO) in 2026, please refer to our full plan details page.
Freedom Blue PPO Valor (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2026 to people living in Western, PA. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Freedom Blue PPO Valor (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Freedom Blue PPO Valor (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Freedom Blue PPO Valor (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $75.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by Freedom Blue PPO Valor (PPO).
Additional Benefits
The Freedom Blue PPO Valor (PPO) plan features affordable cost-sharing with no copay or coinsurance for primary care visits, preventive screenings, and home health services. Specialist visits require a low $10 copay, while inpatient hospital stays incur a $275 copay per admission with no coinsurance. Emergency care is covered with a $130 copay, which is waived if you are admitted to the hospital within three days. This plan also provides valuable dental, vision, and hearing benefits to help reduce your out-of-pocket costs. Members enjoy no copay or coinsurance for covered dental services up to a $3,000 annual maximum, and no copay for eyewear up to a $400 annual limit. Additionally, routine eye and hearing exams require a simple $10 copay, and the plan includes a $100 allowance every three months for over-the-counter items with no copay.
Inpatient Hospital See details
Freedom Blue PPO Valor (PPO) covers inpatient acute hospital stays with a $275 copay per admission and no coinsurance, including unlimited additional days with no copay. Inpatient psychiatric care is also covered with no coinsurance and a copay of $325 per day for days 1 through 3 and no copay for days 4 through 90, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Freedom Blue PPO Valor (PPO) covers outpatient services with no coinsurance, featuring a $245 copay for outpatient hospital and daily observation services alongside a $195 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $5 copay and no coinsurance, while outpatient blood services are available with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Freedom Blue PPO Valor (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Freedom Blue PPO Valor (PPO), requiring a $330 copay and no coinsurance for both ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Freedom Blue PPO Valor (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 3 days. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $130 for emergency care, $40 for urgent care, and $330 for emergency transportation.
Primary Care See details
Freedom Blue PPO Valor (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Additional benefits like physical therapy, mental health, and podiatry require copays ranging from $5 to $15 with no coinsurance, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Freedom Blue PPO Valor (PPO) partially covers preventive services, providing annual physicals, kidney disease education, and routine screenings with no copay and no coinsurance. Memory fitness, remote access technologies (with a $0 to $10 copay and no coinsurance), and home safety devices (with a 20% coinsurance and no copay) are covered, but health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Freedom Blue PPO Valor (PPO) partially covers hearing services, providing one routine hearing exam per year for a $10 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $699 to $999 and no coinsurance up to a $500 annual maximum, but fitting or evaluation services, OTC hearing aids, and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Freedom Blue PPO Valor (PPO), offering one routine eye exam annually for a $10 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $400 annual maximum benefit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Freedom Blue PPO Valor (PPO), which features a $10 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $3,000 annual maximum. While preventive and restorative care are covered, other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Freedom Blue PPO Valor (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Freedom Blue PPO Valor (PPO) plan with 20% coinsurance and no copay.
Medical Equipment See details
Freedom Blue PPO Valor (PPO) covers medical equipment with no copays, though prior authorization is required. Covered items are subject to coinsurance, ranging from no coinsurance to 50% coinsurance for durable medical equipment, 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 20% coinsurance for diabetic equipment and supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Freedom Blue PPO Valor (PPO) plan with no coinsurance, though prior authorization is required. There is no copay for lab services, a $0 to $10 copay for diagnostic procedures, a $20 copay for outpatient X-rays, and minimum copays of $60 for therapeutic radiology and $225 for diagnostic radiology.
Home Health Services See details
Home health services are covered under the Freedom Blue PPO Valor (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Freedom Blue PPO Valor (PPO) plan, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are all not covered in practice.
Skilled Nursing Facility (SNF) See details
Freedom Blue PPO Valor (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO Valor (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $100 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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